Celiac Disease. What I need to know about. National Digestive Diseases Information Clearinghouse NATIONAL INSTITUTES OF HEALTH

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1 What I need to know about Celiac Disease U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH National Digestive Diseases Information Clearinghouse

3 What I need to know about Celiac Disease U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH National Digestive Diseases Information Clearinghouse

4 Contents What is celiac disease?... 1 Is celiac disease serious?... 2 What are the symptoms of celiac disease?... 3 How is celiac disease diagnosed?... 4 How is celiac disease treated?... 5 Eating, Diet, and Nutrition... 6 Points to Remember... 8 Hope through Research... 9 Pronunciation Guide For More Information Acknowledgments... 13

5 What is celiac disease? Celiac disease* is an immune disease in which people can t eat gluten because it will damage their small intestine. Gluten is a protein found in wheat, rye, and barley. Gluten may also be used in products such as vitamin and nutrient supplements, lip balms, and some medicines. Other names for celiac disease are celiac sprue and gluten intolerance. Your body s natural defense system, called the immune system, keeps you healthy by fighting against things that can make you sick, such as bacteria and viruses. When people with celiac disease eat gluten, their body s immune system reacts to the gluten by attacking the lining of the small intestine. The immune system s reaction to gluten damages small, fingerlike growths called villi. When the villi are damaged, the body cannot get the nutrients it needs. *See page 10 for tips on how to say the words in bold type. 1

Celiac disease is hereditary, meaning it runs in families. Adults and children can have celiac disease. As many as 2 million Americans may have celiac disease, but most don t know it.

6 Celiac disease is hereditary, meaning it runs in families. Adults and children can have celiac disease. As many as 2 million Americans may have celiac disease, but most don t know it. Small intestine Villi Villi on the lining of the small intestine help absorb nutrients. Is celiac disease serious? Yes. Celiac disease can be very serious. It often causes long-lasting digestive problems and keeps your body from getting all the nutrition it needs. Over time, celiac disease can cause anemia, infertility, weak and brittle bones, an itchy skin rash, and other health problems. 2

7 What are the symptoms of celiac disease? Symptoms of celiac disease include stomach pain gas diarrhea extreme tiredness change in mood weight loss an itchy, blistering skin rash slowed growth Some people with celiac disease may not feel sick or have symptoms. Or if they feel sick, they don t know celiac disease is the cause. Most people with celiac disease have one or more symptoms. Not all people with celiac disease have digestive problems. Having one or more of these symptoms does not always mean a person has celiac disease because other disorders can cause these symptoms. 3

You must be on your regular diet before the test. If not, the results could be wrong.

8 How is celiac disease diagnosed? Celiac disease can be hard to diagnose because some of its symptoms are like the symptoms of other diseases. People with celiac disease may go undiagnosed and untreated for many years. If your doctor thinks you have celiac disease, you will need a blood test. You must be on your regular diet before the test. If not, the results could be wrong. If your blood test results show you might have celiac disease, your doctor will perform a biopsy, which involves taking a tiny piece of tissue from your small intestine. A biopsy may be performed at a hospital or outpatient center. 4

9 Your doctor will provide you instructions about how to prepare for a biopsy. Generally, no eating or drinking is allowed 8 hours before a biopsy. Smoking and chewing gum are also prohibited during this time. Tell your doctor about any health conditions you may have, especially heart and lung problems, diabetes, and allergies. Also tell your doctor about any medicines you take. You may be asked to stop taking them for a short time before and after the test. To perform the biopsy, the doctor inserts a long, narrow tube into your mouth, down through your stomach, and into your small intestine. At the end of the tube are small tools that the doctor uses to snip out a bit of tissue. The tissue will then be viewed with a microscope to look for signs of celiac disease damage. You will take medicine before the biopsy that makes you sleepy and keeps you from feeling any pain. Many people sleep through the procedure. How is celiac disease treated? The only treatment for celiac disease is a glutenfree diet. If you avoid gluten, your small intestine will heal. If you eat gluten or use items that contain gluten, celiac disease will continue to harm your small intestine. 5

Have regular checkups so your doctor can diagnose and treat problems from celiac disease. Celiac disease can cause problems, such as weak or brittle bones, even if you are on a gluten-free diet.

10 Have regular checkups so your doctor can diagnose and treat problems from celiac disease. Celiac disease can cause problems, such as weak or brittle bones, even if you are on a gluten-free diet. Eating, Diet, and Nutrition A dietitian can help you select gluten-free foods. A dietitian is an expert in food and healthy eating. You will learn how to check labels of foods and other items for gluten. The following chart lists examples of foods you can eat and foods you should stay away from if you have celiac disease. This list is not complete. A dietitian can help you learn what other foods you can and can t eat on a gluten-free diet. 6

11 Amaranth Arrowroot Buckwheat Cassava Corn Flax Indian rice grass Job s tears Legumes Millet Nuts Foods You Can Eat Potatoes Quinoa Rice Sago Seeds Soy Sorghum Tapioca Wild Rice Yucca Wheat Including einkorn, emmer, spelt, kamut Wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein Bromated flour Durum flour Enriched flour Farina Graham flour Foods that Contain Gluten Barley Rye Triticale (a cross between wheat and rye) Other Wheat Products that Contain Gluten Phosphated flour Plain flour Self-rising flour Semolina White flour Processed Foods that May Contain Wheat, Barley, or Rye* Bouillon cubes Brown rice syrup Chips/potato chips Candy Cold cuts, hot dogs, salami, sausage Communion wafer French fries Gravy Imitation fish Matzo Rice mixes Sauces Seasoned tortilla chips Self-basting turkey Soups Soy sauce Vegetables in sauce *Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer. Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago: American Dietetic Association; American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide, please visit 7

12 Points to Remember Celiac disease is an immune disease in which people can t eat gluten or use items with gluten in them. Celiac disease harms the small intestine. People with untreated celiac disease can t get needed nutrients. Without treatment, people with celiac disease can develop other health problems. Celiac disease is diagnosed by blood tests and a biopsy of the small intestine. The only treatment for celiac disease is to avoid gluten. A dietitian can help people choose the right foods. 8

13 Hope through Research The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research on celiac disease. Researchers are studying new options for diagnosing celiac disease, including capsule endoscopy, which involves patients swallowing a capsule containing a tiny video camera that records images of the small intestine. Several drug treatments for celiac disease are being studied. Researchers are also studying a combination of enzymes proteins that aid chemical reactions in the body that might change gluten in ways that prevent it from causing an immune reaction before it enters the small intestine. Scientists are also developing educational materials for standardized medical training to raise awareness among health care providers. The hope is that increased understanding and awareness will lead to earlier diagnosis and treatment of celiac disease. Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit 9

14 Pronunciation Guide biopsy (BY-op-see) celiac disease (SEE-lee-ak) (dih-zeez) dietitian (dy-uh-tish-uhn) gluten (GLOO-tuhn) intestine (in-tess-tin) 10

15 For More Information Celiac Disease Awareness Campaign 2 Information Way Bethesda, MD Phone: TTY: Fax: celiac@info.niddk.nih.gov Internet: American Celiac Society P.O. Box New Orleans, LA Phone: info@americanceliacsociety.org Internet: American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL Internet: Celiac Disease Foundation Ventura Boulevard, #1 Studio City, CA Phone: Fax: cdf@celiac.org Internet: 11

16 Celiac Sprue Association/USA, Inc. P.O. Box Omaha, NE Phone: CSA 4CSA ( ) or Fax: celiacs@csaceliacs.org Internet: Gluten Intolerance Group of North America th Avenue SE Auburn, WA Phone: Fax: info@gluten.net Internet: National Foundation for Celiac Awareness P.O. Box 544 Ambler, PA Phone: Fax: info@celiaccentral.org Internet: 12

17 Acknowledgments Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. The National Digestive Diseases Information Clearinghouse would like to thank William F. Stenson, M.D., Washington University, for assisting with the scientific and editorial review of the original version of this publication. Thank you also to Alice Bast and Nancy Dickens, National Foundation for Celiac Awareness; Cynthia Kupper, R.D., C.D., Gluten Intolerance Group; and Elaine Monarch, Celiac Disease Foundation, for reviewing the food chart. Thank you also to Joseph Murray, M.D., at the Mayo Clinic College of Medicine, Rochester, MN, for facilitating field-testing of the original version of this publication. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. 13

The Celiac Disease Awareness Campaign The National Institutes of Health Celiac Disease Awareness Campaign provides current, comprehensive, science-based information about the symptoms, diagnosis, and

18 The Celiac Disease Awareness Campaign The National Institutes of Health Celiac Disease Awareness Campaign provides current, comprehensive, science-based information about the symptoms, diagnosis, and treatment of celiac disease, also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. The Awareness Campaign is an initiative of the National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases. Download this publication and learn more about the Awareness Campaign at 14

19 National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD Phone: TTY: Fax: nddic@info.niddk.nih.gov Internet: The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at INFO FDA ( ) or visit Consult your health care provider for more information.

20 U.S. DEpArTmENT OF HEALTH AND HUmAN SErVICES National Institutes of Health NIH Publication No March 2011 The NIDDK prints on recycled paper with bio-based ink.

What is celiac disease?

What is celiac disease? Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten,